Primary care and home visiting services for early
identification and support for young children with
developmental difficu...
Content
1. The Critical Window of
opportunity
2. The role of the health sector
in
promotion, prevention, and
early interve...
1. Maximizing the Critical Window of
Opportunity for every child
• Every child is born with potential
• Overwhelming evide...
0 1 4 8 12 16
AGE
Sensing
Pathways
(vision, hearing)
Language
Higher
Cognitive Function
3 6 9-3-6
Months Years
C. Nelson, ...
5
EARLY
RELATIONSHIPS
HEALTH
&
NUTRITION
FAMILY
SUPPORT
PROTECTION
&
INCLUSION
Predictable, responsive
and affectionate ca...
The Health Sector - A Part of the
Problem?
• More newborns are surviving, but only
gradual improvements in perinatal/neona...
2. Why Target the Health Sector?
Health Sector Advantage
• Health workers often
trusted
• Use of services not
stigmatizing...
Continuum of Health Care
Health promotion -> Prevention -> Early Intervention
Examples of Health Promotion
• Promotion of healthy lifestyle
(exercise, rest, smoking and
alcohol cessation, good
nutriti...
Examples of Prevention
“The most effective interventions are often those that are preventative
instead of reactive”
• Foli...
Examples of Early Intervention
• Early interventions for infants
with very low birth weight,
congenital conditions,
disabi...
3. Mapping of Early (0-3 years) Identification
and Intervention Services in CEE/CIS
• All countries/entities in CEE/CIS pa...
a. ECI Mapping study - Policy environment
• 14/23 countries/entities have laws that mandate
access to early intervention s...
b. ECI Mapping study - Access
• Basic health services accessible in 21
countries/entities
• Sufficient doctors and nurses ...
Availability of Child ECI Specialists (Urban Areas)
0
10
20
30
Sufficient
Insufficient
Not at all
Number of Countries/Entities Providing Services to
Most (>75%) Young Children and Mothers
0 2 4 6 8 10 12 14 16
Folic acid...
Services for One-Year Old with Down
Syndrome
White: services not available * countries/entities in random order
Services for six-month old, born
prematurely, birth weight 1400 grams, poor
weight gain, mild spasticity, not vocalizing
W...
Services for 6-months old with severely
depressed mother
White: services not available * Countries/entities in random order
Likelihood of Institutional Placement by Condition
*Countries/entities in random order
ECI mapping - Service Delivery Approach
0 5 10 15 20
Services provided in home
Services provided to the individual
Service...
Conclusion from ECI Mapping Study and other
Assessments
• Medical model and defectology approach are changing slowly
• Inf...
4. HEALTH AND WELLBEING FOR YOUNG
CHILDREN - UNICEF CEE/CIS APPROACHES
• Multi-sectoral focus
• Regional agreement on key
...
Focus on Early Identification and
Intervention
• Disseminate knowledge about
ECI and child wellbeing
• Promote professiona...
Home Visiting – The Global Evidence
Home visiting can contribute to
improved:
• Parental wellbeing (affect spacing
of preg...
Home Visiting Activities (2012 – 2015)
• Country assessments (9 completed)
• International Expert Group
• Development of h...
The first 3 years of a child's life are a time when a child has the greatest
plasticity for growth and development, even u...
Thank you!
Contact:
Bettina Schwethelm
bschwethelm@unicef.org
Expert presentation by Ms. Bettina Schwethelm, Specialist, Early Child Development and Health, UNICEF Regional Office for ...
Expert presentation by Ms. Bettina Schwethelm, Specialist, Early Child Development and Health, UNICEF Regional Office for ...
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Expert presentation by Ms. Bettina Schwethelm, Specialist, Early Child Development and Health, UNICEF Regional Office for CEE/CIS

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Primary care and home visiting services for early identification and support for young children with developmental difficulties and/or disabilities – what is available and what is needed in CEE/CIS?
From 4th Child Protection Forum in Tajikistan, 2013.

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Expert presentation by Ms. Bettina Schwethelm, Specialist, Early Child Development and Health, UNICEF Regional Office for CEE/CIS

  1. 1. Primary care and home visiting services for early identification and support for young children with developmental difficulties and/or disabilities – What is available and what is needed in CEE/CIS? Dushanbe, August 1, 2013 Bettina Schwethelm UNICEF CEECIS Regional Office
  2. 2. Content 1. The Critical Window of opportunity 2. The role of the health sector in promotion, prevention, and early intervention 3. Mapping ECI services for children with disabilities & developmental difficulties in CEE/CIS 4. UNICEF’s work to strengthen the health sector for ECI
  3. 3. 1. Maximizing the Critical Window of Opportunity for every child • Every child is born with potential • Overwhelming evidence from neuro-science and development research about what young children need “survive and thrive” • Critical development during pregnancy and the first 1000 days of life – Sensitive periods of development – Depriving environments significantly affect vulnerable children
  4. 4. 0 1 4 8 12 16 AGE Sensing Pathways (vision, hearing) Language Higher Cognitive Function 3 6 9-3-6 Months Years C. Nelson, in From Neurons to Neighborhoods, 2000 Sensitive/critical periods Critical/sensitive periods during which certain types of stimulation must be received
  5. 5. 5 EARLY RELATIONSHIPS HEALTH & NUTRITION FAMILY SUPPORT PROTECTION & INCLUSION Predictable, responsive and affectionate care; secure bonding and attachment; interaction and communication Access to child health and development knowledge and information Child care services Family and child benefits Early detection and intervention for delays and disabilities Protection from violence, maltreatment and abuse Promotive, preventive and curative health care & adequate and appropriate nutrition
  6. 6. The Health Sector - A Part of the Problem? • More newborns are surviving, but only gradual improvements in perinatal/neonatal care and lack of community-based services • Providers continue to recommend and promote the move of newborns with medical conditions and/or disabilities to institutional settings • Insufficient outreach to the more vulnerable groups for prevention and care due to pervasive stigma and discrimination • Low level of reporting of abuse and neglect with severe consequences for development and lifelong wellbeing • Low attention to maternal depression and other parental disabilities
  7. 7. 2. Why Target the Health Sector? Health Sector Advantage • Health workers often trusted • Use of services not stigmatizing • Continuum of care allows for development of relationship of trust and entry into family micro-environment Coverage Central Asia (range) At least 1 prenatal visit 96-99% Measles vaccine 97-99% Hospital delivery 88-100% Health sector home visiting systems 5 countries WHO definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” requires a much broader role for the health sector.
  8. 8. Continuum of Health Care Health promotion -> Prevention -> Early Intervention
  9. 9. Examples of Health Promotion • Promotion of healthy lifestyle (exercise, rest, smoking and alcohol cessation, good nutrition) during pregnancy • Birth preparedness & parenting information • Provision of age- appropriate parenting advice – Information about child developmental needs – Information on common parenting issues (feeding, crying, toileting , discipline…) – Injury prevention education…..
  10. 10. Examples of Prevention “The most effective interventions are often those that are preventative instead of reactive” • Folic acid to prevent neural tube defect (also iodine and iron deficiency) • Social workers in maternities to reduce abandonment/relinquishment in vulnerable women • Breastfeeding, kangaroo care/skin-to-skin for low birth weight infants for bonding and development • Social-emotional counseling/ support for mothers/parents experiencing depression • Birthing/parent education to support nurturing parent-child relationship • Counseling in responsive feeding
  11. 11. Examples of Early Intervention • Early interventions for infants with very low birth weight, congenital conditions, disabilities and for young children with delays – Counseling and support to caregivers, developmental surveillance, re/habilitation services, referral – Hearing, vision, and child development services • Early interventions for children and families experiencing abuse, neglect, mental health problems, or other adversities – Counseling, referral, treatment, involvement of child and social protection services
  12. 12. 3. Mapping of Early (0-3 years) Identification and Intervention Services in CEE/CIS • All countries/entities in CEE/CIS participated • Approach based on global WHO study with 32 LMICs • Focus on health sector • Key informant approach (1-2 per country) • 37 respondents -- 28 medical doctors (13 pediatricians) and 9 professionals from other disciplines
  13. 13. a. ECI Mapping study - Policy environment • 14/23 countries/entities have laws that mandate access to early intervention services • Most laws recent (between 2004 – 2011) • 12 countries/entities have tools to classify developmental disorders and disabilities
  14. 14. b. ECI Mapping study - Access • Basic health services accessible in 21 countries/entities • Sufficient doctors and nurses in 17 countries/entities • Health Sector home visiting in 20 countries/entities (social services: 7) • > 75% of young children routinely visited in their home in 14 countries • Home visiting for special groups in 10 countries (e.g., Roma) • Continuity of care is essential for children with disabilities and delays – but likelihood of seeing the same provider is less for chronic conditions (which includes disabilities)
  15. 15. Availability of Child ECI Specialists (Urban Areas) 0 10 20 30 Sufficient Insufficient Not at all
  16. 16. Number of Countries/Entities Providing Services to Most (>75%) Young Children and Mothers 0 2 4 6 8 10 12 14 16 Folic acid during pregnancy Prenatal screening for Down syndrome Ultrasound for neural tube Screening of neonate for PKU Screening of neonate for hypothyroidism Developmental surveillance Developmental screening Counseling during home visit on… Identification of intra-family violence (23 countries/entities)
  17. 17. Services for One-Year Old with Down Syndrome White: services not available * countries/entities in random order
  18. 18. Services for six-month old, born prematurely, birth weight 1400 grams, poor weight gain, mild spasticity, not vocalizing White: services not available * Countries/entities in random order
  19. 19. Services for 6-months old with severely depressed mother White: services not available * Countries/entities in random order
  20. 20. Likelihood of Institutional Placement by Condition *Countries/entities in random order
  21. 21. ECI mapping - Service Delivery Approach 0 5 10 15 20 Services provided in home Services provided to the individual Services provided in groups Caregiver present Caregiver not present Family-centered Child-centered
  22. 22. Conclusion from ECI Mapping Study and other Assessments • Medical model and defectology approach are changing slowly • Information about young children with disabilities and delays remains limited – Outdated classification systems – Role of role of social determinants (poverty, ethnicity…) and family needs not addressed • Lack of trained professionals • Low use of evidence-based approaches for promotion, prevention, and intervention • Low use of evidence-based screening and diagnostic tools • Lack of community-based services for early intervention in most countries • Limited understanding of the critical importance of early intervention
  23. 23. 4. HEALTH AND WELLBEING FOR YOUNG CHILDREN - UNICEF CEE/CIS APPROACHES • Multi-sectoral focus • Regional agreement on key approaches, strategies, and results indicators based on best available evidence • Regional support to development of advocacy tools, human capacity building in ECD/ECI, research to generate a regional evidence base, and M&E • A shared web-based platform for collaboration centering on young child wellbeing (including ECI) and health promotion
  24. 24. Focus on Early Identification and Intervention • Disseminate knowledge about ECI and child wellbeing • Promote professionalization of ECI services (“export of Turkey DPU approach”, ECD/ECI skills building) • Strengthen universal and enhanced home visiting services for promotion, prevention and early identification
  25. 25. Home Visiting – The Global Evidence Home visiting can contribute to improved: • Parental wellbeing (affect spacing of pregnancies, maternal health, maternal depression, substance abuse) • Parenting skills and behaviours (e.g., breastfeeding/ responsive feeding, nurturing responsiveness to infant, less harsh discipline, stimulating & safer home environment…) • Child outcomes (health, nutrition, and vaccination; infant sociability, exploration, cognitive growth, executive function…)
  26. 26. Home Visiting Activities (2012 – 2015) • Country assessments (9 completed) • International Expert Group • Development of home visiting policy guidance with focus on vulnerable groups (young children with disabilities/ developmental difficulties) • Regional training package for home visiting personnel with focus on early child development and developmental difficulties • Tool kit to enhance screening and developmental monitoring capacities • Innovation projects and research
  27. 27. The first 3 years of a child's life are a time when a child has the greatest plasticity for growth and development, even under adverse circumstances. The health sector therefore has a unique responsibility, because it has the greatest reach to children and their families during pregnancy, birth, and early childhood. Universal health coverage provides the platform to achieve impact in a fair, integrated, and efficient way. … By ensuring that all children have the best first chance in life, we can help individuals and their communities to realise their maximum potential, thereby expanding equality and opportunity for all. (M. Chan, Director General, WHO, 2013)
  28. 28. Thank you! Contact: Bettina Schwethelm bschwethelm@unicef.org

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